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    New Patient Registration Form

    Contact Details:

    Contact Details:


    Postal Address Same as above?

    Consent to SMS Reminder and Recalls Notifications where applicable:


    Health Card Information


    Next of Kin Details


    Emergency Contact Details

    Consent:

    • Kings Langley Family Practice (KLFP) undertakes research, professional development and quality assurance/improvement activities to improve patient care. All people accessing personal health information for this purpose would have signed a written confidentiality agreement.

    • For the purpose of medical care/treatment relevant personal information may need to be provided to other specialists/providers to enable their involvement with your health management/treatment eg) pathology forms, specialist referrals, care plans etc.

    • I consent to my health record being reviewed as part of the quality improvement activities at this practice and that relevant information is provided when necessary to continue appropriate treatment.

    • The practice uses a reminder/recall system to improve the quality of your health care. I consent to
    being contacted for reminders/recalls/quality improvement activities.